Ophthalmological Society of Nigeria Advisory on COVID-19 Due to the COVID-19 pandemic and the recent announcements by His Excellency President Muhammadu Buhari reducing social interactions and other advisories from The Nigerian Centre for Disease Control and other state governments, it has become imperative for The Ophthalmological Society of Nigeria (OSN) to issue its advisory for all Ophthalmologists. The Ophthalmological Society of Nigeria now finds it essential that all ophthalmologists should immediately cease providing any treatment other than urgent or emergency care. This recommendation is endorsed by the Nigerian Medical Association, West African College of Surgeons and The National Postgraduate College as well as the OSN Board of Trustees. The present reality of the risk of spread of the COVID-19 pandemic is at our doorstep, we have the responsibility to protect not only our patients but ourselves too. Both local and international public health guidelines advice two urgent steps. First, we must reduce the risk of the SARS-CoV-2 virus transmission from human to human and the rate of new case development. Second, we must as a nation conserve needed disposable medical supplies and focus them to the hospitals where they are most needed. Accordingly, the Ophthalmological Society of Nigeria (OSN) strongly recommends that all ophthalmologists provide only urgent or emergency care. To serve as a guide we are attaching a list of possible urgent and emergency cases as suggested by The American Academy of Ophthalmology. We are aware that the dynamics of the pandemic is rapidly changing and the definition of an urgent or emergency case will equally change with different scenarios. As a result, the attached list is simply suggestive and Ophthalmologists are advised to apply careful clinical judgement and consider the effects of the pandemic in each locality. Ophthalmologist are also advised to take extra precautions to prevent being infected or spreading the infection to other colleagues, staff and patients. The use of slit lamp screens, face masks, hand gloves, protective eye wear and full protective personal equipment (PPE) where appropriate is strongly advised. Thorough disinfection of instruments and furniture is also advised at this time. We believe that with all hands on deck we can reduce the spread and mortality from COVID-19.
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Ophthalmological Society of Nigeria Advisory on COVID-19
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Ophthalmological Society of Nigeria Advisory on COVID-19
Due to the COVID-19 pandemic and the recent announcements by His Excellency President Muhammadu Buhari reducing social interactions and other advisories from The Nigerian Centre for Disease Control and other state governments, it has become imperative for The Ophthalmological Society of Nigeria (OSN) to issue its advisory for all Ophthalmologists.
The Ophthalmological Society of Nigeria now finds it essential that all ophthalmologists should immediately cease providing any treatment other than urgent or emergency care. This recommendation is endorsed by the Nigerian Medical Association, West African College of Surgeons and The National Postgraduate College as well as the OSN Board of Trustees.
The present reality of the risk of spread of the COVID-19 pandemic is at our doorstep, we have the responsibility to protect not only our patients but ourselves too. Both local and international public health guidelines advice two urgent steps.
First, we must reduce the risk of the SARS-CoV-2 virus transmission from human to human and the rate of new case development. Second, we must as a nation conserve needed disposable medical supplies and focus them to the hospitals where they are most needed.
Accordingly, the Ophthalmological Society of Nigeria (OSN) strongly recommends that all ophthalmologists provide only urgent or emergency care. To serve as a guide we are attaching a list of possible urgent and emergency cases as suggested by The American Academy of Ophthalmology. We are aware that the dynamics of the pandemic is rapidly changing and the definition of an urgent or emergency case will equally change with different scenarios. As a result, the attached list is simply suggestive and Ophthalmologists are advised to apply careful clinical judgement and consider the effects of the pandemic in each locality.
Ophthalmologist are also advised to take extra precautions to prevent being infected or spreading the infection to other colleagues, staff and patients. The use of slit lamp screens, face masks, hand gloves, protective eye wear and full protective personal equipment (PPE) where appropriate is strongly advised. Thorough disinfection of instruments and furniture is also advised at this time. We believe that with all hands on deck we can reduce the spread and mortality from COVID-19.
Several institutions around the world have developed protocols to be adopted by ophthalmologists to safeguard the health of the patients and the physicians. One of such, that is home grown, is that of University of Abuja Teaching Hospital which is recommended for use by our members. The document is also attached as an appendix.
Please be safe.
Thank you.
Bade Ogundipe
OSN President
3rd April, 2020
APPENDIX 1 List of possible urgent and emergency cases as suggested by American Academy of Ophthalmology
Surgical Procedure Indications
Biopsy of orbit Suspected malignancy or immediate sight-threatening condition
Biopsy of temporal artery Suspected giant cell arteritis
Brachytherapy Intraocular malignancy
Cantholysis Sight-threatening conditions
Canthotomy Sight-threatening conditions
Cataract surgery Congenital cataract in the amblyopic period, monocular patients with documented vision loss precluding driving, reading or self-care, lens-induced glaucoma, angle-closure glaucoma, acute lens complications, or severe anisometropia of fellow eye post recent lens extraction in first eye
Closure of cyclodialysis cleft Sight-threatening hypotony due to trauma
Corneal transplantation Pediatric patients with corneal blindness in both eyes in their amblyopic period
Decompression of dacryocele Neonate with obstructive respiratory compromise
Decompression of orbit Orbital tumor with impending vision loss
Drainage of abscess Orbital cellulitis
Drainage of choroidals Appositional choroidal effusion, suprachoroidal hemorrhage, or flat anterior chamber
Evisceration Sight-threatening infection, or intractable pain
Examination under anesthesia Pediatric patients with retinoblastoma, endophthalmitis, Coats Disease, uveitis, glaucoma, ocular trauma, retinal detachment, or presumed intraocular foreign body
Excision of tumors Malignancy or sight-threatening tumor
Exenteration Life-threatening infection
Exploration of orbit Life-threatening or sight-threatening conditions
Fenestration of optic nerve sheath Progressive vision loss
Filtration surgery (XEN45 gel stent) Uncontrolled intraocular pressure that is sight-threatening who are poor candidates for trabeculectomy or aqueous tube shunts
Repair of orbital fracture Hemodynamic instability or oculocardiac reflex
Repair of perforation or impending Corneal and scleral injury or trauma
Retrobulbar injection Pain due to ocular diseases causing significant compromise of quality of life
Revision of drainage implant with or without graft
Implant/tube exposure that might be sight threatening, endophthalmitis, malpositioned tube endangering eye or excessive inflammation, a tube that might worsen vision due to corneal edema or iritis or cystoid macular edema, or with a severe tube malposition causing rapid visual loss
Scleral buckle Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, or intraocular foreign body
Strabismus surgery Torn or lost extraocular muscle
Synechiolysis Lens-induced glaucoma or angle-closure glaucoma
Tarsorrhaphy Impending corneal compromise
Trabeculectomy with or without scarring Catastrophic or rapidly progressive glaucoma and markedly elevated intraocular pressure, or uncontrolled secondary or primary glaucoma
Trabeculotomy Uncontrolled intraocular pressure that is sight-threatening
Transscleral cyclophotocoagulation Uncontrolled glaucoma or absolute glaucoma with a blind and painful eye
Vitrectomy Retinal detachment, ocular trauma, intraocular infection, vitreous hemorrhage, retinal tear, intraocular foreign body, misdirected aqueous, ciliary block glaucoma, malignant glaucoma, a vitreous prolapse, or a tube shunt that blocks filtration
Washout of the anterior chamber Hyphema that is sight-threatening
perforation of cornea or sclera
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Practical Safety for Patients and Providers AT THE EYE CLINIC:
Standard infection prevention and control measures
INTRODUCTION
The novel coronavirus (SARS-CoV-2) is a zoonotic virus which causes coronavirus
disease (COVID-19) that could result in severe respiratory tract infections, and fatal
respiratory distress. Clinical signs and symptoms include dry cough, fever,
shortness of breath and conjunctivitis. The World Health Organization (WHO) has
declared COVID-19 a pandemic which is increasingly spreading across geographical
boundaries daily (WHO, 11 March 2020).
The aim of this communication is to provide clinical practice advisory and health
education messages to eye care workers, as a reminder for standard infection
prevention and control measures to prevent spread of communicable diseases for
all healthcare workers when attending to patients.
How to protect yourself: ADVISE to Eye Care Workers
The health of the physician and medical staff is a top priority. Therefore, we have to
be physically and mentally health-aware to provide good service to people. Tears,
sweat and other body fluids may be media for viral transmission
Examining the patient
1. Protective equipment - Maintaining the health of medical staff and providing
them with personal protective equipment (PPE) is a priority. These include
appropriate use of face masks, gloves, goggles and gowns.
Comment: This is a big challenge that health care professionals and their
associations should press on employers to provide PPE at the work place. The
health care professionals should also imbibe culture of use of protective